- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.44 / $4,760.00 / $7,726.98
| Facility | | $3,405.44 | $4,760.00 | $7,726.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,634.44 / $9,431.85 / $12,092.11
| Facility | | $6,634.44 | $9,431.85 | $12,092.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,832.70 / $7,410.17 / $9,372.53
| Facility | | $3,832.70 | $7,410.17 | $9,372.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.44 / $5,119.04 / $8,185.57
| Facility | | $3,405.44 | $5,119.04 | $8,185.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,982.62 / $6,810.34 / $10,346.87
| Facility | | $3,982.62 | $6,810.34 | $10,346.87 |